The counseling profession has increasingly embraced a medicalized vision of counseling processes. The latest manifestation of this vision is the best practices (BP) movement. This movement is critically examined to determine if it is consistent with the traditional values of the counseling profession. The author concludes that BP ideology is inconsistent with the value the counseling profession has traditionally placed on the counseling relationship and diversity.
In recent years, efforts to medicalize the counseling profession have greatly increased. Evidence for the medicalization of the profession includes the demands for greater diagnostic training in counseling curricula (Hansen, 2003), counselors' participation in diagnosis and treatment planning while working in counseling centers (Hansen, 1997), and the best practices (BP) movement within the counseling profession (McGowan, 2003). The BP movement is, therefore, the latest manifestation of an increasing trend toward empiricism and medicalization in the counseling profession.
The mission of the BP movement is to identify particular treatments that are optimal for treating particular disorders (McGowan, 2003). Thus, the BP ideology is directly modeled after the medical model, which posits prescriptive treatments for particular, identifiable conditions (Wampold, 2001). This ideological trend has also been referred to as empirically supported treatments. However, I am referring to the prescriptive treatment trend within the counseling profession as the BP movement, given that the flagship journal of the American Counseling Association, the Journal of Counseling & Development, has recently instituted a Best Practices section (McGowan, 2003), thereby setting a linguistic precedent for the counseling profession to refer to the specific treatment for specific disorders movement as best practices.
It is surprising, given the core humanistic values of the counseling profession, that there have been few critical responses to the increased dominance of the BP movement within counseling (Hansen, 2003). Indeed, BP has been described as a way "to promote excellence in the counseling profession" (McGowan, 2003, p. 388). This uncritical acceptance of BP might seem warranted, because it may be difficult to fathom that a reasonable person could criticize practice that is "best." However, I contend that this language (i.e., "best") has the effect of obscuring some of the more pernicious side effects of the specific treatment for specific disorders movement. Therefore, the purpose of this article is to systematically examine the conceptual foundation of the BP movement to determine if it is consistent with the values of the counseling profession.
Endorsement of the Specificity Hypothesis
Throughout the history of counseling practice, theorists and researchers have attempted to identify the elements of counseling that cause positive changes in clients. Two important camps have emerged out of this debate: one that hypothesizes that the specific features of particular treatment orientations cause change (i.e., specificity hypothesis or medical model) and the other that presumes factors common to all counseling orientations are responsible for healing (i.e., common factors or contextual hypothesis; Wampold, 2001). For instance, when a cognitive orientation is used to successfully treat clients who are depressed, the specificity camp would argue that the specific techniques of the cognitive orientation, such as refraining and challenging distorted cognitions, are responsible for the positive outcomes. The common factors camp, alternatively, would maintain that specific techniques probably had very little to do with the alleviation of depression. Rather, factors common to all counseling orientations, which are present in cognitive treatments, such as support, instillation of hope, and the positive regard of the counselor, actually caused the positive treatment outcome. …